Epworth Application Form

This Application Form must be accompanied by:

1. The applicant’s birth certificate, a passport photo and latest school report.
2. A copy of both parents’ ID and the ID of the person responsible for the account (if not parents).
3. A non-refundable application fee of R600 (this covers all administrative costs including credit clearances).

Download the application form [PDF | XLS ] or fill in the form below :

Pupil Details :

Surname :

Country of Birth :

Nationality :

ID Number :

Religious Affiliation and Denomination :

Present Grade :

Gender : FemaleMale

First Name/s :

Date of Birth :

Home Language :

Passport Number (If not a SA Resident) :

Application for Grade (Please enter the year):

BoarderDay Scholar

Please give details of any sibling/s (Name/s, Grade/s and School/s) :

Full School History (Name of School, Grades and Tel No/s) :

Parents Marital Status : MarriedDivorcedWidowedSingleRe-married

With whom does the applicant live? :

Father's / Guardian's Details :

Title :

Surname :

First Names :

ID Number :

Date of Birth :

Home Address :

Postal Address :

Home Tel No :

Work Tel No :

Fax No :

Cell No :

Email :

Business / Employer :

Occupation :

Position Held :

Mother's Details :

Title :

Surname :

First Names :

ID Number :

Date of Birth :

Home Address :

Postal Address :

Home Tel No :

Work Tel No :

Fax No :

Cell No :

Email :

Business / Employer :

Occupation :

Position Held :

Details of Person / Name of Trust / Company / CC etc. liable for the account:

If not a Parent or Guardian please complete the following :

Names or Contact Person :

ID / Reg Number :

Home / Street Address :

Home Tel No :

Fax No :

Relationship to applicant :

Postal Address :

Work Tel No :

Cell No :

E-Mail :

Does your family have any connection with Epworth?

If yes, please give details, relationship and years at Epworth.

How did you hear about Epworth?

Past Pupils : YesNo

Present Pupils : YesNo

Advertisements : YesNo

Press Reports : YesNo

Promotional Talks : YesNo

Exhibitions / Open Days : YesNo

Friends : YesNo

Other

I / We hereby consent to Epworth School obtaining and utilising any credit bureau records and information that it may
require for tracing and credit, risk and affordability, assessment purpose or any other purpose which it in its sole
discretion may deem necessary as well as the reporting or releasing of any such information to any other person,
to the extent required or permitted by law.